M6: Synovial fluid Flashcards by Geno Alinsub

Synovial fluid

All statements are correct about synovial fluid except one.

A. Viscous liquid found in the cavities of movable joints.
B. Diarthroses
C. Provides nutrients directly to the bones in a joint.
D. Serves as a lubricant to reduce friction.

provide nutrients to the articular cartilage

inamo wakin, magsamasama kau

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Synovial fluid is often referred to as?

joint fluid

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bones in the synovial joints are lined with

smooth articular cartilage

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Bones are separated by a cavity containing the

synovial fluid

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All statements are correct about synovial fluid except one.

A. Joint is enclosed in a fibrous joint capsule, lined by cartilage and lubricated by synovial membrane fluid.
B. Type A cells are macrophage-like cells located in the
superficial layer.
C. Type B cells are fibroblast-like cells that produce hyaluronic
acid fibronectin, and collagen.
D. Provides nutrients to the articular cartilage.

cartilage lining should actually be the synovial membrane lining the capsule
synovial fluid is responsible for lubrication, not synovial membrane fluid.

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TOF. Synovial fluid is formed as an ultrafiltrate of plasma across the articular cartilage.

F (formed as an ultrafiltrate of plasma across the synovial membrane)

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All are correct except:

A. The filtration is nonselective except for the exclusion of high-molecular-weight proteins.
B. Most of the chemical constituents, although
seldom of clinical significance, have concentrations similar to plasma values.
C. They provide nutrients for the vascular-deficient cartilage.
D. Lessens the shock of joint friction that occurs during activities such as sitting and standing

shock from compression, not friction
impact activities, not sitting and standing

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NORMAL SYNOVIAL FLUID VALUES

TOF. 4.5 mL volume of synovial

F (<3.5)

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NORMAL SYNOVIAL FLUID VALUES

TOF. Varies from being entirely transparent to a faint shade reminiscent of yellow

Normal Color

thx chatgpt

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NORMAL SYNOVIAL FLUID VALUES

Clarity

Clear

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NORMAL SYNOVIAL FLUID VALUES

Viscosity

Able to form a string 4 to 6 cm long

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NORMAL SYNOVIAL FLUID VALUES

TOF. Leukocyte count 4,000 - 6,000

F (<200 cell/uL)

None present

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NORMAL SYNOVIAL FLUID VALUES

TOF. Neutrophils: <25%

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NORMAL SYNOVIAL FLUID VALUES

TOF. Glucose: Plasma
difference: <20 mg/dL lower than the blood glucose level

F (10)

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NORMAL SYNOVIAL FLUID VALUES

Total protein

<3 g/dL

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SPECIMEN COLLECTION AND HANDLING

Synovial fluid is collected by needle aspiration called

arthrocentesis

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TOF. The normal amount of fluid in the adult knee cavity is less
than 3.5 mL, but can increase to greater than 25 mL with
inflammation.

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SPECIMEN COLLECTION AND HANDLING

TOF. Fluid from a
diseased joint may not clot.

F (Normal synovial fluid does not clot; however, fluid from a
diseased joint may contain fibrinogen and will clot)

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SPECIMEN COLLECTION AND HANDLING

TOF. Therefore, fluid is often collected in a syringe that has been moistened with oxalate.

heparin

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Required Tube Type

Gram Stain and culture
Glucose analysis
Cell counts
All other tests

A. Sodium Fluoride or Non-anticoagulated tube
B. EDTA or Heparin
C. SPS or sterile heparinized
D. Sodium Oxalate or Non-anticoagulated tube
E. Nonanticoagulated tube

C, A, B, E

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SPECIMEN COLLECTION AND HANDLING

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SPECIMEN COLLECTION AND HANDLING

ALL ARE CORRECT EXCEPT ONE:

A. Powdered anticoagulants should not be used.
B. The anticoagulated tube for other tests must be centrifuged and separated.
C. Specimens for crystal analysis should not be refrigerated.
D. All testing should be done as soon as possible to prevent cellular lysis and possible changes in crystals.

B (nonanti)

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The word “synovial” comes from the Latin word for?

egg, ovum

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Normal viscous synovial fluid resembles

egg white

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# COLOR AND CLARITY color becomes a deeper yellow | anong clinical significance

noninflammatory and inflammatory effusions

# COLOR AND CLARITY greenish tinge

bacterial infection

# COLOR AND CLARITY Turbidity is frequently associated with the following except: A. Synoviocytes B. Fat droplets C. Minerals D. Synovial cell debris E. NOTA

C ## Footnote WBCs, RBCs, synoviocytes, crystals, fat droplets, synovial cell debris, and fibrin

# COLOR AND CLARITY When crystals are present the fluid may appear

Milky fluid

Synovial fluid viscosity comes from?

polymerization of the hyaluronic acid

# VISCOSITY This affects both the production of hyaluronate and its ability to polymerize, thus decreasing the fluid viscosity.

Arthritis

# VISCOSITY Hyaluronate polymerization can be measured using a?

Ropes, or mucin clot, test

# VISCOSITY Reagents of Ropes

2% to 5% acetic acid

# VISCOSITY When added to a solution of 2% to 5% acetic acid, normal synovial fluid forms a?

solid clot surrounded by clear fluid

# VISCOSITY The mucin clot test is reported in terms of (match good, fair, low, poor): * Friable clot * Soft clot * No clot * Solid clot

* Low * Fair * Poor * Good

# VISCOSITY TOF. The mucin clot test is not routinely performed, because all forms of arthritis decrease viscosity and little diagnostic information is obtained.

most frequently performed cell count on synovial fluid

Total Leukocyte Count

# CELL AND DIFFERENTIAL COUNTS TOF. White blood cell (WBC) counts are seldom requested.

F (RBC)

# CELL AND DIFFERENTIAL COUNTS This is performed as soon as possible or the specimen should be refrigerated to prevent cellular disintegration.

Cell counts

# CELL AND DIFFERENTIAL COUNTS Very viscous fluid may need to be done, except: A. Pretreated by adding one drop of 5% hyaluronidase in phosphate buffer per milliliter B. Incubating at 37°C for 5 minutes C. Pretreated by adding one drop of 0.05% hyaluronidase in phosphate buffer per milliliter

# CELL AND DIFFERENTIAL COUNTS Manual counts on thoroughly mixed specimens are done using?

Neubauer counting chamber

# CELL AND DIFFERENTIAL COUNTS TOF. Clear fluids can usually be counted undiluted, but dilutions are necessary when fluids are turbid or bloody

# CELL AND DIFFERENTIAL COUNTS TOF. Traditional WBC diluting fluid can be used

F (contains acetic acid, it may produce a clot)

# CELL AND DIFFERENTIAL COUNTS TOF. 0.9g of NaCl dissolved in 100mL of sterile water can be used as a diluent.

T (Normal saline pa rin 'yan)

# CELL AND DIFFERENTIAL COUNTS Suitable diluent necessary to lyse the RBCs

hypotonic saline (0.3%) or saline that contains saponin

# CELL AND DIFFERENTIAL COUNTS Methylene blue added to the normal saline stains the?

WBC nuclei

# CELL AND DIFFERENTIAL COUNTS This diluent permits the separation of the RBCs and WBCs during counts performed on mixed specimens

Methylene blue

# CELL AND DIFFERENTIAL COUNTS Normal WBC count

WBC counts less than 200 cells/uL

# CELL AND DIFFERENTIAL COUNTS Differential counts should be performed on?

cytocentrifuged preparations or on thinly smeared slides

# CELL AND DIFFERENTIAL COUNTS Prior to slide prep, fluid should be incubated with

hyaluronidase

# CELL AND DIFFERENTIAL COUNTS TOF. Neutrophils should account for less than 25% of the differential count and monocytes less than 15%.

F (lymphocytes <15%)

# CELL AND DIFFERENTIAL COUNTS Increased neutrophils indicate a

septic condition

# CELL AND DIFFERENTIAL COUNTS an elevated cell count with a predominance of lymphocytes suggests a

nonseptic inflammation

# CELL AND DIFFERENTIAL COUNTS In both normal and abnormal specimens, cells may appear

more vacuolated

# CELL AND DIFFERENTIAL COUNTS primary cells seen in normal synovial fluid

Mononuclear cells ## Footnote monocytes, macrophages, and synovial tissue cells

# CELL AND DIFFERENTIAL COUNTS may be present after crush injuries

lipid droplets

# CELL AND DIFFERENTIAL COUNTS seen in cases of pigmented villonodular synovitis

Hemosiderin

# MATCH DESCRIPTIONS 1. Reiter cell 2. LE cell 3. Synovial lining cell 4. Macrophage (monocyte) 5. Lymphocyte A. Similar to macrophage, but may be multinucleated, resembling a mesothelial cell B. Mononuclear leukocyte C. Vacuolated macrophage with ingested neutrophils D. Large mononuclear leukocyte, may be vacuolated E. Neutrophil containing characteristic ingested “round body”

1. C 2. E 3. A 4. D 5. B

# MATCH SIGNIFICANCE 1. Reiter cell 2. LE cell 3. Synovial lining cell 4. Macrophage (monocyte) 5. Lymphocyte A. Lupus erythematosus B. Normal Disruption from arthrocentesis C. Crystal-induced inflammation & Non-septic inflammation D. Reactive arthritis (infection in another part of the body) E. Normal Viral infections

D, A, B, E, C

# MATCH CELL/INCLUSION 1. Neutrophil 2. RA cell 3. CartilaGe cells 4. Rice bodies 5. Fat Droplets 6. Hemosiderin A. Vacuolated macrophage with ingested neutrophils B. Microscopically show collagen and fibrin C. Neutrophil with dark cytoplasmic granules containing immune complexes D. Refractile intracellular and extracellular globules E. Inclusions within clusters of synovial cells F. Large, multinucleated cell

1. C 2. A 3. F 4. B 4. D 5. E

# MATCH SIGNIFICANCE 1. Neutrophil 2. RA cell 3. Cartilage cells 4. Rice bodies 5. Fat Droplets 6. Hemosiderin A. Bacterial sepsis B. Rheumatoid arthritis Immunologic inflammation C. Osteoarthritis D. Traumatic injury Chronic inflammation E. Tuberculosis Septic and rheumatoid arthritis F. Pigmented villonodular synovitis

ABCEDF

# CRYSTAL IDENTIFICATION Microscopic examination of synovial fluid for the presence of crystals is an important diagnostic test in evaluating?

arthritis

This formation in a joint frequently results in an acute, painful inflammation

Crystal

# CRYSTAL IDENTIFICATION Causes of crystal formation include metabolic disorders and decreased renal excretion that produce the following, EXCEPT: A. Elevated blood levels of crystallizing chemicals B. Oral administration of medications, such as antihistamines C. Degeneration of cartilage and bone D. Injection of medications, such as corticosteroids E. NOTA

# CRYSTAL IDENTIFICATION primary crystals seen in synovial fluid are (2)?

* monosodium urate (uric acid): gout * calcium phosphate dihydrate: pseudogout

# CRYSTAL IDENTIFICATION most frequent causes of gout, increased serum uric acid results from, except: A. Impaired metabolism of purines B. Increased consumption of low-purine-content foods C. Alcohol, and fructose D. Chemotherapy treatment of leukemias E. Decreased renal excretion of uric acid

# CRYSTAL IDENTIFICATION most often associated with degenerative arthritis, producing cartilage calcification and endocrine disorders that produce elevated serum calcium levels

Pseudogout

# CRYSTAL IDENTIFICATION present may include talcum powder and starch from gloves, precipitated anticoagulants, dust, and scratches on slides and cover slips. Slides and cover slips should be examined and if necessary, cleaned again before use

Artifacts

# CHARACTERISTICS OF SYNOVIAL FLUID CRYSTALS Needles

Monosodium urate

# CHARACTERISTICS OF SYNOVIAL FLUID CRYSTALS ?:Rhomboid square, rods

Calcium pyrophosphate Dihydrate

# CHARACTERISTICS OF SYNOVIAL FLUID CRYSTALS Notched, rhomboid plates

Cholesterol

# CHARACTERISTICS OF SYNOVIAL FLUID CRYSTALS Flat, variable-shaped plates

Corticosteroid

# CHARACTERISTICS OF SYNOVIAL FLUID CRYSTALS ?:Envelopes

Calcium oxalate

# CHARACTERISTICS OF SYNOVIAL FLUID CRYSTALS Small particles Require electron microscopy

Apatite (calcium phosphate)

# CHARACTERISTICS OF SYNOVIAL FLUID CRYSTALS Negative birefringence

* Monosodium urate * Cholesterol * Corticoteroid * Caox

# CHARACTERISTICS OF SYNOVIAL FLUID CRYSTALS Positive birefingence

* Calcium pyrophosphate * Corticosteroid (siya ay both posi and nega)

# CHARACTERISTICS OF SYNOVIAL FLUID CRYSTALS No birefringence

Apatite (calcium phosphate)

# CHARACTERISTICS OF SYNOVIAL FLUID CRYSTALS Match the clinical significance 1. Monosodium urate 2. Calcium pyrophosphate 3. Cholesterol 4. Corticosteroid 5. Calcium oxalate 6. Apatite A. osteoathritis B. renal dialysis C. injections D. extracellular E. pseudogout F. gout

FEDCBA

# SLIDE PREPARATION TOF. Both MSU and CPPD crystals are reported as being located extracellularly and intracellularly (within neutrophils); therefore, fluid must be examined after WBC disintegration.

before WBC disintegration

# SLIDE PREPARATION TOF. Fluid is examined as an unstained wet preparation.

# SLIDE PREPARATION The slide is examined under what magnification? using what microscope?

LPO and HPO; regular light microscope

# SLIDE PREPARATION Crystals (such as MSU and CPPD) can be seen in? | anong smear

Wright’s-stained smears

# SLIDE PREPARATION TOF. Wright-stained smears can be solely relied on for accurate identification.

F (the wet prep examination and the use of polarized and red-compensated polarized light for identification)

# SLIDE PREPARATION * They may be extracellular or located within the cytoplasm of neutrophils. * They are frequently seen sticking through the cytoplasm of the cell. * they lyse phagosome membranes and therefore do not appear in vacuoles.

Monosodium urate (uric acid) (MSU)

# SLIDE PREPARATION They are usually located within vacuoles of the neutrophils

CPPD

# SLIDE PREPARATION To avoid misidentification of CPPD crystals, the classic rhomboid shape should be observed and confirmed with?

red compensated polarized microscopy

Once the presence of the crystals has been determined using direct polarization, positive identification is made using?

first-order red-compensated polarized light

# CRYSTAL POLARIZATION A control slide for the polarization properties of MSU can be prepared using?

betamethasone acetate corticosteroid light

# CRYSTAL POLARIZATION this is is more highly birefringent and appears brighter against the dark background.

Monosodium urate

# CRYSTAL POLARIZATION What is placed in the microscope between the crystal and the analyzer, when compensated polarized light is used?

red compensator

# CRYSTAL POLARIZATION separates the light ray into slow-moving and fast-moving vibrations and produces a red background

compensator

# CRYSTAL POLARIZATION * molecules run parallel to the long axis of the crystal * when aligned with the slow vibration, the velocity of the slow light passing through the crystal is not impeded as much as the fast light, which runs against the grain and produces a yellow color * This is considered negative birefringence (subtraction of velocity from the fast ray).

MSU crystals

# CRYSTAL POLARIZATION * molecules run perpendicular to the long axis of the crystal * when aligned with the slow axis of the compensator, the velocity of the fast light passing through the crystal is much quicker, producing a blue color * positive birefringence.

CPPD crystals

# CRYSTAL POLARIZATION When the crystals are aligned perpendicular to the slow vibration, the color is?

reversed

# CRYSTAL POLARIZATION MSU: Direction of compensator ray is parallel to the crystal and is what color

yellow

# CRYSTAL POLARIZATION MSU: Direction of compensator ray is perpendicular to the crystal and is?

Blue

# CRYSTAL POLARIZATION CPPD: Direction of compensator ray is parallel to the crystal and is?

Blue

# CRYSTAL POLARIZATION Direction of compensator ray is perpendicular to the crystal and is?

Yellow

# CHEMISTRY TESTS most frequently requested test

glucose determination

# CHEMISTRY TESTS markedly decreased glucose values indicate

inflammatiory (g2) and septic (g3)

# CHEMISTRY TESTS TOF. Normal synovial fluid glucose values are based on the blood glucose level.

# CHEMISTRY TESTS Fasting hours for glucose

8 hours

# CHEMISTRY TESTS Normal values: 1. Synovial fluid glucose 2. Total protein 3. Uric Acid A. less than 2.0 mmol/L B. 6 to 8 mg/dL C. not exceed 10 mg/dL below the blood value D. less than 3 g/dL

CDB

# CHEMISTRY TESTS Glucose: 10 and 20 mg/dL | indicator for

Non-inflammatory and hemorrhagic joint disorders

# CHEMISTRY TESTS Glucose: 0 to 40 mg/dL below plasma level

Inflammatory disorders

# CHEMISTRY TEST 20 to 100 mg/dL or 0 to 80Glucose: mg/dL less than the plasma level

Infectious and crystal-induced

# CHEMISTRY TEST Because the large protein molecules are not filtered through the synovial membranes, normal synovial fluid contains

less than 3g/dL protein

# CHEMISTRY TEST Increased levels of total protein

inflammatory and hemorrhagic disorders

# CHEMISTRY TEST TOF. Synovial fluid protein measurement does not contribute greatly to the classification of these disorders, inflammatory and hemorrhagic

# CHEMISTRY TEST demonstration of an elevated this may be used to confirm the diagnosis when the presence of crystals cannot be demonstrated in the fluid

uric acid level

# CHEMISTRY TESTS often measured as a first evaluation in suspected cases of gout.

Uric acid

# CHEMISTRY TESTS Increased in septic arthritis caused by gram-positive cocci and gram-negative bacilli

lactate

# CHEMISTRY TESTS Arthritis caused by ## Footnote lactate values are normal or low

Neisseria gonorrhoeae

# CHEMISTRY TESTS Lactate: Levels greater than 9 mmol/L (81 mg/dL) indicate

bacterial arthritis and immediate onset of treatment

# CHEMISTRY TESTS to monitor the severity and prognosis of rheumatoid arthritis (RA).

Enzymes

# MICROBIOLOGIC TESTS may occur as a secondary complication of inflammation caused by trauma or through dissemination of a systemic infection

infection

# MICROBIOLOGIC TESTS two of the most important tests performed on synovial fluid.

culture & g/s

# MICROBIOLOGIC TESTS organisms are often missed on what test

g/s

# MICROBIOLOGIC TESTS most frequently seen infection

bacterial

# MICROBIOLOGIC TESTS Routine bacterial cultures should include an?

enrichment

# MICROBIOLOGIC TESTS the common organisms that infect synovial fluid are the

fastidious Haemophilus species and Neisseria gonorrhoeae.

# MICROBIOLOGIC TESTS For instance, the organism is difficult to grow in a culture, molecular method is performed using?

PCR

# MICROBIOLOGIC TESTS PCR: Lyme Disease Arthritis | give genus and spp

# MICROBIOLOGIC TESTS PCR: osteoarticular tuberculosis | give the genus and spp

# MICROBIOLOGIC TESTS PCR: Chlamydia trachomatis and N. gonorrhoeae | give the disease

venereal arthritis

# SEROLOGIC TESTS present in the serum of most patients with RA

RF (rheumatoid factor)

# SEROLOGIC TESTS TOF. RF is present in the serum of most patients with RA, whereas just more than half of these patients will demonstrate **RF** in synovial fluid

# SEROLOGIC TESTS o Cause very serious joint inflammation o Diagnosed in the serology laboratory by demonstrating the presence of their autoantibodies in serum.

Rheumatoid Arthritis and Systemic Lupus Erythematosus

# SEROLOGIC TESTS Arthritis is a frequent complication of Lyme disease. Therefore, demonstrating antibodies to the?

Borrelia burgdorferi

# Microbiological test Causative agent of lyme disease arthritis

Borrelia burgdorferi

# Microbiological test Causative agent of osteoraticular tuberculosis

M. tuberculosis

# Microbiological test Causative agent of venereal arthritis

Chlamydia trachomatis & N. gonorrhoeae

M6: Synovial fluid Flashcards

(131 cards)